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The effects of person-based and hospital-based factors on outcomes of hospitalisation for people with dementia in NSW Australia. Brian Draper, Natalie Chan, Rosemary Karmel , Diane Gibson, Ann Peut , Charles Hudson, Phil Anderson, Kasia Bail, Laurie Grealish. Background.

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  1. The effects of person-based and hospital-based factors on outcomes of hospitalisation for people with dementia in NSW Australia Brian Draper, Natalie Chan, Rosemary Karmel, Diane Gibson, Ann Peut, Charles Hudson, Phil Anderson, Kasia Bail, Laurie Grealish

  2. Background • People with dementia are high users of acute hospitals – approx 25% of persons with dementia in NSW hospitalised in 2006/7 (Draper et al, 2011) • Outcomes of people with dementia are worse than those without dementia • Longer LOS • Increased Mortality • Increased risk of Adverse Events • Increased risk of transfer to residential care (Draper et al, 2011; Watkin et al 2011; Mukadam & Sampson, 2011)

  3. Research Aim • To determine the influence of hospital- and community-based aged care and dementia services on outcomes of hospitalisation for people with dementia in the state of New South Wales (NSW), Australia in 2006/7.

  4. NSW, Australia • Population approx 7 million • 198 public hospitals About 1100 kilometres Sydney

  5. Methodology Data from three sources were integrated to provide information about each patient and their first public hospital stay: • For demographic and clinical information, data were extracted from the NSW Admitted Patient Data Collection for 2006/7 (n = 252,719), including n= 20,800 with dementia. • Data about the availability of hospital-based aged care and dementia services and staff were obtained through a survey of NSW public hospitals (n =163, response rate 82%). • Regional provision levels of community-based care and residential care were extracted from the Aged and Community Care Management Information System

  6. Methodology • Multiple linear analyses were undertaken to determine patient characteristics, hospital services and regional service provision factors associated with length of stay (LOS) for people with and without dementia. • Negative binomial distribution was used to account for skewness in LOS. Metric: days • Compared risk of death, residential aged care placement and inter-hospital transfers for people with and without dementia

  7. Explanatory variables controlled for in analyses • Patient characteristics: • Demographics: age group, sex, marital status, socioeconomic status (SEIFA), country of birth, Aboriginal and/or Torres Strait Islander status • Health: Principal diagnosis, extent of comorbidity, principal procedure • Stay characteristics: • Admission day (weekday/weekend), inter-hospital transfer • Admitting hospital characteristics: • Size, rurality (major city/outside), hospital type (acute only/subacute), presence of preadmission services, presence of emergency department with or without specialist aged care staff) • Hospital characteristics during stay: • Specialist staff: Specialist medical aged care staff (Permanent, visiting or none), interface position • Policies: Dementia, delirium • Staff education: Dementia forums • Facilities: Secure beds, rehabilitation beds, residential aged care beds • Services: Memory clinic, respite services, day hospitals, post-discharge services (last hospital) • Discharge destination: • Returned to community, new admission to RAC, return to RAC, died, other

  8. Age, Dementia Status & LOS Dementia Mean LOS = 16.5 days, Median = 7 days Without Dementia Mean LOS = 8.9 days, Median = 4 days ** p<.01; *** p<.001

  9. Demographics, Dementia Status & LOS * p<.05; ** p<.01; *** p<.001;

  10. Principal diagnoses with Strongest Influence on LOS

  11. Characteristics of hospital stay & LOS * p<.05; ** p<.01; *** p<.001

  12. Admitting hospital characteristics & LOS *p<.05; ** p<.01; *** p<.001;

  13. Specialist staff, policies, education  p<.1; * p<.05; ** p<.01; *** p<.001;

  14. Services and facilities *p<.05; ** p<.01; *** p<.001;

  15. Regional aged care provision *p<.05; ** p<.01; *** p<.001;

  16. Discharge hospital and destination a. Other: Reported as transfer to other, psychiatric hospital, hospital or unknown;  p<.1; * p<.05; ** p<.01; *** p<.001;

  17. Summary • LOS is influenced by various patient, diagnostic, hospital and community service factors • Some factors have similar effects on LOS of people with and without dementia e.g. Comorbidity, policies, hospital transfers • Other factors have different effects on people with and without dementia

  18. Summary • For people with dementia: • LONGER: Being younger • SHORTER: Admitted on weekend, RAC beds in hospital, being a RAC resident • For people without dementia: • LONGER: being older, married, admitted on weekend, larger hospital, greater RAC provision in community, being a RAC resident • SHORTER: presence of ED, secure beds, respite services and a day hospital

  19. Future directions • Hospital- and community- factors that are associated with likelihood of admission to RAC and death in hospital • Multi-level modelling approach to allow the differential influence of factors at the stay, patient and hospital level on hospitalisation outcomes to be examined.

  20. Thank you……. Any questions? Contact us: Email:hds@aihw.gov.au Web:www.aihw.gov.au/hospital-dementia-services-project Brian Draper: b.draper@unsw.edu.au

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